University of Groningen, University Medical Center Groningen, Department of Surgery, 9700 RB Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Neurology, 9700 RB Groningen, The Netherlands.
Age Ageing. 2022 Feb 2;51(2). doi: 10.1093/ageing/afab237.
Post-operative delirium (POD) is associated with increased morbidity and mortality rates in older patients. Neuroinflammation, the activation of the intrinsic immune system of the brain, seems to be one of the mechanisms behind the development of POD. The aim of this study was to explore the association between the perioperative inflammatory response and the development of POD in a cohort of older oncological patients in need for surgery.
In this prospective cohort study, patients 65 years and older in need for oncologic surgery were included. Inflammatory markers C-reactive protein (CRP), interleukin-1 beta (IL-1β), IL-6, IL10 and Neutrophil gelatinase-associated lipocalin (NGAL) were measured in plasma samples pre- and post-operatively. Delirium Observation Screening Scale (DOS) was used as screening instrument for POD in the first week after surgery. In case of positive screening, diagnosis of POD was assessed by a clinician.
Between 2010 and 2016, plasma samples of 311 patients with median age of 72 years (range 65-89) were collected. A total of 38 (12%) patients developed POD in the first week after surgery. The perioperative increase in plasma levels of IL-10 and NGAL were associated with POD in multivariate logistic regression analysis (OR 1.33 [1.09-1.63] P = 0.005 and OR 1.30 [1.03-1.64], P = 0.026, respectively). The biomarkers CRP, IL-1β and IL-6 were not significantly associated with POD.
Increased surgery-evoked inflammatory responses of IL-10 and NGAL are associated with the development of POD in older oncological patients. The outcomes of this study contribute to understanding the aetiology of neuroinflammation and the development of POD.
术后谵妄（POD）与老年患者的发病率和死亡率增加有关。神经炎症，即大脑固有免疫系统的激活，似乎是 POD 发展背后的机制之一。本研究的目的是探讨围手术期炎症反应与需要手术的老年肿瘤患者 POD 发展之间的关系。
在这项前瞻性队列研究中，纳入了 65 岁及以上需要接受肿瘤手术的患者。在术前和术后采集血浆样本，测量炎症标志物 C 反应蛋白（CRP）、白细胞介素-1β（IL-1β）、IL-6、IL-10 和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。术后第一周使用谵妄观察筛查量表（DOS）作为 POD 的筛查工具。如果筛查阳性，则由临床医生评估 POD 的诊断。
在 2010 年至 2016 年间，共采集了 311 名中位年龄为 72 岁（范围 65-89 岁）患者的血浆样本。共有 38 名（12%）患者在术后第一周发生 POD。多变量逻辑回归分析显示，IL-10 和 NGAL 血浆水平的围手术期升高与 POD 相关（OR 1.33 [1.09-1.63]，P=0.005 和 OR 1.30 [1.03-1.64]，P=0.026）。CRP、IL-1β 和 IL-6 这三个生物标志物与 POD 无显著相关性。
IL-10 和 NGAL 的手术诱发炎症反应增加与老年肿瘤患者 POD 的发生有关。本研究的结果有助于了解神经炎症的发病机制和 POD 的发生。
